Healthcare Provider Details

I. General information

NPI: 1457237026
Provider Name (Legal Business Name): MAYRA MORA-MORALES MRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 CALLE CIPRES
SAN JUAN PR
00924-5115
US

IV. Provider business mailing address

702 CALLE CIPRES
SAN JUAN PR
00924-5115
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-7714
  • Fax: 787-764-7714
Mailing address:
  • Phone: 787-764-7714
  • Fax: 787-764-7714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number709
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: